A data bridge “built of connection and hope” that integrates primary care and public health

January 31, 2023

4 minutes to read

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In Alberta, Canada, stakeholders built a data bridge between independent primary care providers and public health officials to share information about SARS-CoV-2 test results and ultimately improve community responses to the pandemic.

The researchers said that these efforts published in annals of family medicine, Providing insights to other jurisdictions considering strategies to integrate primary care and public health.


Miles Leslie, PhD, MJ, MA, Primary care has been central to supporting public health initiatives, delivering care within the community — including immunizations — and reducing the burden of emergencies, an assistant professor and associate director of research in the University of Calgary’s School of Public Policy, and colleagues write. and acute care facilities to keep the health system resilient, but “their experiences of being integrated into the pandemic response are not well understood.”

“With a focus on achieving universal health care and sustainable development, WHO has stressed the importance of integrating primary care into broader health systems,” the researchers write. “Integration into primary care It aims to bring together a diverse group of individuals and professionals to deliver care to those with complex health needs while eliminating duplication or gaps in service.”

In any situation where testing and caregiving responsibilities are divided, “it’s important that test results flow smoothly into primary care,” Leslie said.

To learn more about how to bridge the data, Leslie and colleagues conducted 57 qualitative, semi-structured interviews with public health and primary care stakeholders within the Calgary Health District.

The researchers found that SARS-CoV-2 test results for the local public laboratory were initially available to central public health physicians but not to independent primary care providers.

“This enabled centrally managed contact tracing, but meant that primary care physicians were unaware of their patients’ COVID-19 status and unable to provide follow-up care within the community,” they wrote.

However, stakeholders have leveraged “a political commitment to the patient-medical-home (PMH) model of care, and a combination of existing organizational structures, and governance arrangements to create a data bridge that will bridge the gap.”

According to Leslie, PMH (which in the United States is referred to as PCMH), “seeks to place a patient in a stable team of primary care professionals who then work together to ensure that care is not only available, but accessible on the patient’s terms.”

“The primary care team focuses on treating the whole person (not just their illnesses) in the long term and seeks to help patients manage their well-being through prevention and a range of non-medical interventions that may include physical therapy, mental health counseling, nutritional counseling, etc. “.

Leslie further explained that PMH paved the way for bridging data because it was an “embedded value and a ‘natural’ way for people to think about the primary care aspect of [what would become] the bridge.”

“The core principles of PMH – its focus on patients and ensuring access to and use of technology to manage population health – were the lens through which primary care personnel saw the problem and could therefore imagine a solution,” he said.

This sponsorship model and other policy mandates that focus on integration, the researchers write, are part of the foundation upon which Data Bridge is built. The rest was organizational structures that brought stakeholders together to work on integration projects and “governance arrangements that created relationships and spaces where improvisation could happen”.

Leslie said the data bridge shifted from a spreadsheet of SARS-CoV-2 test results from the central lab that public health officials had “manually combed” to an automated, encrypted data path from the central lab directly to the primary care provider.

“The data bridge in the article was built from threads of linkage and hope in the beginning, and then over time different stakeholders were able to give it some real resources and IT muscle,” said Leslie. “Test results — whether a patient had COVID-19 positive or negative — was simply sitting in a central lab database or was streaming into a public health unit with nowhere to go, finally had a place to go. They were directed toward the doctors whose patients they were. So patients can provide care and management advice in the community.”

Without a well-established functional interface between the central health system and primary care, the researchers write, day-to-day primary care integration efforts and epidemiological responses are likely to be affected. But there is a silver lining.

“Working to build data bridges and thus access primary care teams to data testing is not only possible, but achievable,” Leslie said.

For any primary care systems seeking to learn from data bridge building, Leslie and colleagues write that they might consider ways to work on organization and governance structures that bring primary care and non-primary care stakeholders together to work on joint projects and “leverage the care commitments model for integration.” .

They concluded that “such policies and structures develop relationships of trust, open the possibility for protagonists to emerge, and create spaces in which integrative improvisation can occur.”

In an accompanying editorial, Trisha GreenhalghAnd OBE, FRCP, FRCGP, FMedSciAnd The study “demonstrates how the key role of primary care appears to have been overlooked in the midst of an emergency response,” wrote the professor of primary care at the University of Oxford.

“Like many of us [family doctors] Find out in the early months of 2020, it’s difficult to provide comprehensive care to individuals or proactive advice to families and communities in a fast-moving pandemic when we don’t have access to the tests or test results that others have requested.”


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